Clean goes green

When it comes to infection prevention and environmental stewardship, long-term care operators are taking a page out of acute care's book. Increasingly, they're trading traditional cleaning products for less toxic, equally effective alternatives, and switching to solutions — and suppliers — that cut product and packaging waste.

It's a move that's not only good for the environment, but also the health and wellness of residents, staff and visitors. Risks associated with conventional cleaning products and methods have been well-documented.

Many products contain high levels of volatile organic compounds that can cause or exacerbate respiratory irritation, headaches and other symptoms in building occupants, according to Practice Greenhealth. What's more, the organization reports that roughly 35% of conventional cleaning products can cause severe skin damage and also damage organs if absorbed through the skin. Furthermore, disposal of some cleaning products contributes to ground and water contamination, jeopardizing aquatic habitats and organisms, the U.S. Environmental Protection Agency states.

The Sanctuary at the Park is one such facility. For more than five years, the Muskegon, MI-based facility has made a concerted effort to select more environmentally friendly infection control products, while also adopting cleaning methods that reduce waste and exposure to toxic chemicals.

“Clean, healthy and safe environments are our main focus,” says Mark Carlson, environmental services director for The Sanctuary at the Park. “There is a real human side to this — where chemical exposure can take a significant toll on housekeepers, residents [and other building occupants]. We are doing our part to minimize those risks.”

Less can be more
Today, operators will find a broad range of effective green cleaning products available — from all-purpose cleaners, hand hygiene solutions and toilet bowl cleaners to floor strippers, disinfectants and more. In many cases, going green won't require sacrificing the bottom line, either. Healthcare's growing demand for eco-friendly products has helped drive down prices, while increasing competition in the marketplace means vendors are working harder than ever to develop products that rival or even surpass their conventional counterparts.

While many solutions and chemicals are less toxic, eco-focused infection prevention also can come in the way of biodegradable containers and pared-down packaging. Improved dispensing systems that help prevent product overuse and cross-contamination offer yet another opportunity to align infection prevention with environmental efforts.

Courtland Gardens Nursing & Rehabilitation Center in Randallstown, MD, takes a multi-pronged approach to eco-focused infection prevention — from diligent product selection to focused training and recycling. Traditional rag-and-open buckets that once led staff to redip rags and potentially contaminate the solution in the bucket have been swapped for biodegradable wipes and a closed-bucket system that prevents double-dipping. And when it's time to replenish the wipes, staff doesn't have to open — and later dispose of — another plastic container.

“They now just provide us the refill wipes. Any time you're able to cut down on packaging and waste disposal, that's going to be a good thing for the environment,” says Michael Hartman, Courtland Gardens' assistant director of environmental services. Concentrated solutions and automatic dispensing systems that deliver the precise amount of quaternary disinfectant for high-touch, solid surfaces have helped Sanctuary at the Park ensure that staff aren't over- or under-using the product, according to Carlson.

Concentrated formulas also mean a reduction in the amount of plastic entering the waste stream, adds Mark Lessem, vice president of Medline Industries' Ready Care division. Still, they must be used with caution.

“When purchasing highly concentrated solutions, ensure that the packaging is captive, that is, makes it difficult for the end user to come in contact with the chemical prior to dilution,” Lessem says. “The chemicals can be corrosive.”
Vendors are now delivering more products that can pull double- or even triple-duty, allowing facilities to pare down their supplies. Hydrogen peroxide-based products are just one example. Although they won't offer heavy-duty disinfection, they're an effective all-purpose product for glass cleaning, light degreasing and carpet spot cleaning.

Products that turn tap water into liquefied ozone also are making their way into the pipeline. Some vendors in this segment report that when the water is charged, it becomes more powerful than bleach, making it effective against nearly all bacteria and viruses, including C. difficile and methicillin-resistant staphylococcus aureus.

Ultraviolet-emitting technology and copper ion solutions may also reduce operators' reliance on potentially toxic chemicals. Medline Industries markets a mobile UV-C (high intensity ultraviolet light) room disinfection system that has been shown to dramatically reduce pathogens found on surfaces within healthcare settings. The system applies an automatically determined UV-C dose to selected rooms and can destroy multi-drug-resistant organisms.

A typical room is treated in less than 15 minutes. An on-board documentation system tracks which rooms have been treated, when and by whom.

“Copper is eco-friendly. It gets installed, works forever and is 100 percent recyclable,” she says.

Recycled benefits
Reusable products, such as microfiber mop heads, also are gaining ground in long-term care. Microfiber mops can trap more dirt and contaminants than traditional rag mop heads, and can last a month or two, depending upon use.

They also require less water and cleaning solution.

“We use a single mop per room so we're not spreading dirt [and contaminants] from one room to the next,” said Carlson, adding that a pH-neutral cleaner is preferred because it cleans well, yet doesn't damage floors. The microfiber mop heads are then laundered together in a preset laundry cycle to ensure proper cleaning and disinfection.

With hand washing cited as the number one factor in infection prevention, it's no wonder hand-washing products and delivery systems also are getting an overhaul. Replacing refillable liquid soap dispensers with sealed soap cartridges and fresh nozzles is one notable trend.

“Delivery systems that dispense liquid refillable soaps have permanent nozzles that rarely, if ever, get thoroughly cleaned. Airborne bacteria can settle on nozzles and get introduced into the soap reservoir,” explains Drenik.

Facilities that prefer alcohol-based hand sanitizers can help the environment, too. Not only do they eliminate the demand for water and paper towels for hand drying, sanitizers are also being bottled in lighter-weight containers.

Some bottles are even made from recyclable polyethylene terephthalate, a material with good barrier properties against oxygen and carbon dioxide.

“PET uses 30 percent less material than rigid high-density polyethylene, but with no loss of durability,” Drenik says.
Single-dispensing automated towel dispensers also can boost infection prevention efforts and aid waste reduction. Georgia-Pacific Professional has an automated touchless towel dispenser, for example, that cuts cross-contamination risks, while one-at-a-time dispensing reduces waste by up to 30% versus standard folded towels, says Amy White, marketing manager for Georgia-Pacific Professional's healthcare segment. Center-pull tissue dispensers that completely enclose the roll are another hygienic option. These dispensers ensure that users only touch one sheet at a time, which reduces cross-contamination.

Beyond the chemistry
Partnering with infection prevention product vendors that use eco-friendly manufacturing processes is another way facilities can make a positive impact. While it may not always be possible to switch to fully green cleaning or disinfectant formulas, environmental stewardship is still possible through waste reduction and improved manufacturing techniques, stresses J. Hudson Garrett, Jr., PhD, MSN, MPH, FNP, VA-BC, senior director of clinical affairs for PDI Healthcare. Many PDI infection prevention products are made from sustainable or recyclable applicators and packaging.

Of course, even the best products and manufacturing processes won't have an impact if long-term care operators' own infection prevention policies and practices are subpar. Ongoing education is critical, according to Hartman.

Courtland Gardens' environmental services team has safety huddles to discuss proper infection prevention protocols. Environmental services staff follow a set cleaning process for each room. They pull resident trash first, high dust, disinfect high-touch surfaces and then finish with the bathroom (toilets last) and floors. Isolation rooms are always cleaned last, using a bleach mixture.

Staff also must recognize that effective disinfection hinges on proper product use, dilution and contact time. Cleaning crews have to understand “the importance of keeping surfaces wet for the contact time listed on the label,” Lessem warns.

“If the surface dries prior to the contact time requirement, there is a good chance that full disinfection will not be achieved.”